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The bottom line

After ensuring there is no airway and cardiorespiratory compromise, a careful clinical assessment should include preceding events, accompanying symptoms (such as extent of epistaxis, deformity), and damage to adjacent structures

Refer people with nasal fractures and obvious nasal deformity but no other injuries to the ear, nose, and throat (ENT) department within 7-14 days

Nasal injuries are a common presentation to emergency departments and primary care settings. Acute nasal injury often occurs as a result of trauma and can lead to epistaxis, nasal fracture, or even nasal septal haematoma. Epistaxis accounts for 33% of all admissions to emergency ear, nose, and throat (ENT) departments and head and neck surgery facilities, and it can require cautery or packing.1 Occasionally surgical intervention might be required. Nasal fractures are the third most common type of fracture and the most common type of facial fracture.23 The nasal spine lengthens and begins to ossify at around 3 years of age, completing its growth and ossification during puberty.4 Nasal fractures are therefore predominantly seen in the adult population. The incidence of nasal fractures is rising in the United Kingdom, especially among girls and women, and is most commonly caused by assault.5 Other forms of trauma, such as sporting injury, account for most other cases. Nasal septal haematomas are rarer, but require urgent evaluation to prevent nasal deformity.

A recent study showed that after clinical teaching to junior emergency doctors, appropriate nasal examination and documentation rates increased from 30% to 97%,6 and the rate of unnecessary facial and nasal radiographs performed also decreased from …